Jesse Lee Wied, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

02241R Issued in LA

Practice address

1815 Roselawn Ave
Monroe, LA 71201-5433

Phone

(318) 322-7050

Fax

(318) 322-7031

NPI assigned

Sep 30, 2005

Last updated

Oct 25, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jackson Parish Therapy Center LLC

  dba Fyzical Therapy & Balance Centers

  • Physical Therapist
  • Ruston, LA
  • NPI 1891794491
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1194712687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 ROSELAWN AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015433",
            "telephone_number": "318-322-7050",
            "fax_number": "318-322-7031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 ROSELAWN AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015433",
            "telephone_number": "318-322-7050",
            "fax_number": "318-322-7031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIED",
        "first_name": "JESSE",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "02241R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1551813",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William White, PT
• Jennifer Seward Whited, JENNIFER WHITED
• Andrea Whitley
• Jacinda Marie Whitley, PHD, LMFT
• Rhonda Whitlock
• Kami Worley Wiedeman, NP-C
• Cathy Wiley
• Greta McCaa Wiley, LAC, CCGC
• Latasha R Wiley
• Vonthisha C Wiley, LCSW

• Physical Therapist in Monroe, LA
• Providers in Monroe, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.